Untitled Behavioral Treatment for ADHD

This
untitled behavioral treatment is a multi-component intervention that was
developed for children with ADHD. An evaluation found that combining behavioral
treatment with medication management was more successful in treating ADHD and
oppositional defiant disorder (ODD) symptoms than was medication management
alone. However, behavioral treatment alone was not more successful than
community care in treating ADHD and ODD symptoms. A follow-up study at 10 months
found that children who received medication management or medication management
and the behavioral intervention had fewer ADHD and ODD symptoms than those who
received only the behavioral intervention or community care. However there were
no differences between those who received medication management along with the
behavioral intervention and those who received only medication management, or
between those who received the behavioral intervention alone and those who
received only community care.

DESCRIPTION OF PROGRAM

Target population:
Children with ADHD

The
intervention is implemented over the course of 14 months. The behavioral
treatment involves parent training, child-focused treatment, and a school-based
intervention. The parent training consists of 27 group sessions and eight
individual sessions conducted by a therapist-consultant. The child-focused
treatment is an intensive behavioral intervention administered by
counselor/aides and supervised by therapist-consultants as part of a summer
treatment program. It involves individualized academic skills practice and
reinforcement of appropriate classroom behavior. The school-based treatment
consists of 10 to 16 sessions of biweekly teacher consultation on classroom
behavior management strategies, and twelve weeks of a paraprofessional aide
working part-time with the child. The intervention is designed to have an impact
on the outcomes of ADHD symptoms, ODD symptoms, social skills, internalizing
symptoms, parent-child relations, and academic achievement.

Evaluated population:
The sample was 579 children
ages 7 to 10 with ADHD. The average age was 8.5 years. The sample was 80 percent
male, 61 percent white, 20 percent African American, and 8 percent Hispanic.

Approach: Participants were randomly assigned to medication management, behavioral
treatment, combined behavioral treatment and medication management, or community
care (control). Medication management involved a 28-day trial to determine the
best dose, and then 30-minute monthly medication maintenance sessions with a
pharmacotherapist. Community care involved standard treatment by community
providers. Children’s ADHD and ODD symptoms were assessed through parent and
teacher ratings before treatment, at three and 9 months into treatment, and at
the end of treatment. Parent and teacher ratings were averaged, and anyone with
low symptom severity (not at all or just a little of the behavior) according to
this calculation was considered to have had a successful treatment.

Results: The
success rate for the combined treatment was higher than the success rate for
medication management alone. However, the success rate for the behavioral
intervention alone was no better than the success rate for community care.

Evaluated population:
540 children, of the 579 in
Study 1, who participated in the ten-month follow-up. The average age was 8.4
years, and the sample was 80 percent male, 61 percent white, 19 percent black,
and 9 percent Hispanic.

Approach: See
Study 1 for randomization procedure. At ten-month follow-up children were
assessed on ADHD and ODD symptoms, academic achievement, negative or ineffective
discipline, and social skills.

Results: Participants in the medication management and combined treatment groups had
fewer ADHD and ODD symptoms compared with those in the behavioral and community
care conditions. However, there were no differences in symptoms between the
medication management and combined treatment groups or between the behavioral
intervention and community care groups. The treatment had no impact on negative
or ineffective discipline, social skills, or academic achievement.

Study 3

MTA
Cooperative Group. (2004). National Institute of Mental Health multimodal
treatment study of ADHD follow-up: Changes in effectiveness and growth after the
end of treatment. Pediatrics, 113,762-769.

Evaluated population:
The same sample as in Study
2.

Approach: See
Study 1 for randomization procedure. Assessments of ADHD symptoms at post-test
and 10-month follow-up were compared.

Results: All
groups experienced an increase in severity of ADHD symptoms between post-test
and follow-up, but their symptom levels were still lower at follow-up than at
baseline. However, there was a larger increase in ADHD symptoms for participants
in the medication management condition and in the medication management plus
behavioral intervention condition.

MTA
Cooperative Group. (2004). National Institute of Mental Health multimodal
treatment study of ADHD follow-up: Changes in effectiveness and growth after the
end of treatment. Pediatrics, 113,762-769.